Table 1

Timeline of key paediatric emergency department (ED) interventions.

DateInterventionRationale
23 Jan 2020*Mandatory admission to inpatient isolation wards for all suspect cases presenting to the ED (case definitions in online supplementary appendix 1)Containment and isolation purposes as Singapore confirmed first imported case of COVID-19
31 Jan 2020Enhanced personal protective equipment (PPE): N95 face mask for front-line ED staff at triage and in the resuscitation areaIncreasing numbers of imported COVID-19 cases in Singapore
5 Feb 2020
  • All patients with community-acquired pneumonia requiring inpatient admission admitted to an isolation ward

  • *All patients with recent travel to China seen in ED isolation area

  • Local transmission reported in Singapore

  • Significant human-to-human transmission in more than one province of China

9–10 Feb 2020
  • Pre-triage screening of all patients and caregivers

  • Segregation of ED into high-risk, intermediate-risk and low-risk areas

  • ED medical manpower split into modular teams

  • Further PPE enhancement with eye protection for triage, high-risk and intermediate-risk areas

  • Singapore’s national risk assessment raised to Orange (second-highest level)4

  • Evidence of healthcare personnel in China getting infected with COVID-195

  • Evidence of possible ocular transmission of COVID-196

14 Feb 2020*COVID-19 nasopharyngeal swab for patients with community-acquired pneumonia discharged from EDEnhanced surveillance for COVID-192
28 Feb 2020COVID-19 nasopharyngeal swab for patients with travel history outside Singapore within last 14 days and fever/acute respiratory illnessIncreasing local transmission in several countries
5 March 2020*COVID-19 nasopharyngeal swab for asymptomatic paediatric close contacts of confirmed cases (proactively identified; brought to ED for testing)Asymptomatic paediatric patients may have high COVID-19 viral load9
  • *Interventions mandated at national level. All other interventions were decided at hospital level.